Provider Demographics
NPI:1396179297
Name:JOHNSON, KIRSTEN E (RN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 QUIVAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4916
Mailing Address - Country:US
Mailing Address - Phone:303-602-6794
Mailing Address - Fax:909-602-6804
Practice Address - Street 1:500 QUIVAS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4916
Practice Address - Country:US
Practice Address - Phone:303-602-6794
Practice Address - Fax:909-602-6804
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN 0202028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse